Ultrasonography And Contrast-enhanced Ultrasound For Activity Assessment With Carotid Involvement Of Takayasu Arteritis

Objective:To use contrast-enhanced ultrasonography(CEUS)to semi quantitatively grade of carotid artery enhancement in patients with Takayasu arteritis(TA),and to explore the value of CEUS and vascular ultrasound in evaluating the inflammatory activity of carotid artery wall in TA patients.Methods:According to the ACR classification standard,59 TA patients were included.According to NIH score and CEUS contrast-enhanced ultrasound enhancement grade,the patients were divided into clinical activity group,clinical inactivity group,and enhancement grade 0,1,2,and 3 groups.Apply GE E9 or TOSHIB Apli0500 to all subjects who meet the inclusion criteria for routine vascular ultrasonography and CEUS examination.Record the patient’s age,gender,and heart rate,measure the patient’s height,body mass,body mass index(BMI),existing clinical symptoms,record the mean arterial pressure(MBP),the erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and the use of hormones and immunosuppressants were detected.The NIH score,were recorded according to the collected clinical data and laboratory examination.Ultrasound images were used to measure the largest vessel’s outer diameter,the vessel wall’s thickness,the inner diameter of the narrowest lumen,and the degree of stenosis of the involved carotid artery,and the CEUS enhancement degree of the carotid artery is recorded.To analyze the correlation between carotid CEUS and conventional ultrasound parameters and clinical disease activity parameters in TA patients,as well as the predictive value of the combination of CEUS and wall thickness on disease activity.Results:1.Analysis of carotid artery CEUS results:Among the 59 TA patients,28 cases were in the CEUS 0/1 grade group,10 cases were in the 2nd grade group,and 21 cases were in the 3rd grade group,there is no statistical significance(P>0.05)between the groups.ESR,vessel outer diameter,and vessel wall thickness in grade 2 and grade 3 groups were higher than those in grade 0/1 group,and increased with the increase of CEUS grade(P<0.05),and the NIH score in grade 3 group was higher than 0/1 Grade group(P<0.05),the proportion of CRP and clinical activity in grade 2 and grade 3 groups was higher than that in grade 0/1 group(P<0.05).2.Correlation analysis between carotid artery CEUS and conventional ultrasound parameters and disease activity:Carotid artery CEUS enhancement grade,wall thickness,and vessel outer diameter were positively correlated with NIH score,ESR,and CRP.Among them,CEUS showed the best correlation.Among ultrasound parameters,CEUS enhancement level was positively correlated with vessel wall thickness and vessel outer diameter.3.Analysis of the accuracy of CEUS and conventional ultrasound parameters in predicting disease activity:the area under the curve for predicting disease activity with wall thickness≥1.95 mm was 0.682(95%CI was 0.547-0.818,P<0.001),and the sensitivity was 70%,the specificity was 64%;the area under the curve of CEUS>2 predicting disease activity was 0.782(95%CI was 0.659-0.906,P<0.001),the sensitivity was 77%,and the specificity was 80%;CEUS 3 predicting disease activity The area under the curve for activity was 0.725(95%CI 0.595-0.854,P<0.001),with a sensitivity of 53%and a specificity of 92%.4.Analysis of the accuracy of the combination of CEUS and conventional ultrasound parameters in predicting disease activity:the area under the curve of CEUS>2 combined with wall thickness to predict disease activity was 0.804(95%CI was 0.6860.922,P<0.001),and the sensitivity.The specificity was 80%,and the specificity was 81%,which was significantly different from the accuracy of predicting disease activity using wall thickness alone(P=0.011),and had no significant difference from the accuracy of predicting disease activity using CEUS≥ 2 alone(P>0.05).Conclusions:1.There is a significant correlation between CEUS enhancement grade of carotid artery wall and TA clinical activity index.2.Carotid artery wall CEUS enhancement grade≥ 2 has high accuracy in predicting TA disease activity.3.Carotid artery wall thickness combined with CEUS enhancement can effectively evaluate the activity of TA.